October 2018

ASCRS•ASOA UPDATE

In the Journal of Cataract & Refractive Surgery October 2018

Transepithelial photorefractive keratectomy: review study

Soheil Adib-Moghaddam, MD, Saeed Soleyman-Jahi, MD, Ali Sanjari Moghaddam, MD, Niloofar Hoorshad, MD, Ghazale Tefagh, MD, Ali Haydar, MD, Marjan Razi-Khoshroshahi, MD, Samuel Arba Mosquera, PhD
The use of transepithelial photorefractive keratectomy (transPRK) was initially introduced with the aim of forestalling issues with conventional PRK and LASIK. However, transPRK, which is usually followed by PRK in the two-step platform, when compared to conventional PRK was not seen to be superior in terms of safety or efficacy. Better comparative safety results were found, however, using the single-step transPRK epithelial and stromal ablation, using an Amaris laser (Schwind eye-tech-solutions, Kleinostheim, Germany). New improvements to the Amaris laser have included reverse single-step transPRK and use of smart pulse technology to offer a smoother stromal bed counter after ablation. A modified nomogram was also used in a refined single-step platform for determination of ablation parameters, which in hyperopia resulted in better comparative results. Investigators think that more substantial evidence could be gleaned with use of comparative trials comparing these new methods with other modern laser-assisted approaches.

Influence of the vitreolenticular interface in pediatric cataract surgery

Jan Van Looveren, MD, Arnout Vael, MD, Nick Ideler, MD, Hedwig Sillen, MD,
Danny Mathysen, PhD, Marie-José Tassignon, MD
In this prospective case series, investigators set out to examine the impact that the condition of the Berger space as well as abnormal growth of the vitreolenticular interface can have on complications during primary posterior continuous curvilinear capsulorhexis in pediatric cataract cases. Of the 64 pediatric cataract cases included here, 35 abnormalities were found in the Berger space. In cases with persistent fetal vasculature as well as those with posterior cataract, investigators found that there was most likely to be anterior vitreolenticular interface abnormalities, with significantly more occurring when there was posterior capsule plaque and a unilateral cataract. During such pediatric cases, breaks in the anterior hyaloid membrane occurred in 58.6% of cases, with unintended vitrectomy arising in 13.8% due to the fact that the primary continuous curvilinear capsulorhexis was more surgically demanding. In all but one of these pediatric cases, investigators found that it was possible to use bag-in-the-lens IOL implantation. Investigators concluded that during pediatric cataract surgeries, especially those involving a PCP in a unilateral cataract, they often encountered primary vitreolenticular interface abnormalities. They stressed that the primary posterior continuous curvilinear procedure may ultimately be complicated by the presence of anterior vitreolenticular interface abnormalities, which may at times result in an unintended anterior vitrectomy.

A phase 3, prospective, randomized, open label, parallel-design, multicenter study to evaluate the safety of IBI-10090 for inflammation associated with cataract surgery

Eric Donnenfeld, MD, Kerry Solomon, MD, Cynthia Matossian, MD
This prospective randomized multicenter trial of 194 patients compared the impact of anterior chamber intracameral dexamethasone suspension IBI-10090 for treating inflammation after cataract surgery with use of prednisolone acetate 1% drops. Patients were either given a 5 microliter intracameral injection of IBI-10090 or told to take one drop of prednisolone four times a day for 3 weeks following the procedure. Investigators found that 96.8% of the 130 patients who received the IBI-10090 completed the trial, as did 94.5% of those receiving the prednisolone acetate. There were no serious adverse events related to the treatment, although there were two serious unrelated occurrences reported. There was no significant difference in the decrease in endothelial cell density found when the treatment groups were compared. Systemic adverse events were slightly more common in the prednisolone patients, occurring at a rate of 10.9% versus 7.9% of those receiving the IBI-10090. Investigators determined that at the postoperative 8-day mark, 51.6% of those who had received IBI-10090 had attained anterior chamber cell clearing compared with 50.9% of those in the prednisolone group. By the 90-day mark, 98% of all eyes had attained such clearing. When asked whether not having to use eye drops was convenient, 68.7% of those
given the intracameral IBI-10090 strongly agreed that this was an asset, as did 39.2% of those who took the prednisolone drops, who acknowledged they would have preferred the dropless approach. Investigators concluded that while there was similar safety and efficacy with the two approach, the IBI-10090 was ultimately favored.